Kilili: Prompt Medicaid spending helping effort to fix 2019 funding cliff


Delegate Gregorio Kilili Camacho Sablan (Ind-MP) said yesterday he appreciates that the CNMI is spending its Medicaid grant money promptly. It helps him make the case to extend funding next year. The delegate was able to add $109 million for the Marianas Medicaid program in the Affordable Care Act, or Obamacare, beginning in 2011. The funding expires, however, at the end of fiscal year 2019.

“The Commonwealth is using its Obamacare money well,” Sablan said. “The extra money helped keep the hospital open, even after local funding was cut.

“And the $109 million will almost entirely be spent down by the end of 2019.

“Next year, with a possible Democratic majority, this funding cliff, and a very good spending track-record by the CNMI I think we have an excellent shot at extending—even increasing—Medicaid funding.”

One problem with extending the Obamacare funding in the current Congress is that the Republican majority has focused on killing Obamacare.

Another difficulty is slow spending in other territories. Data provided by the Congressional Research Service to Sablan indicates that Guam will have spent 69 percent of available funding and American Samoa only 20 percent by the end of 2019.

The CNMI by contrast is projected to spend 93 percent of its money.

Congress did provide some short-term Medicaid assistance for Puerto Rico and the Virgin Islands in the wake of Hurricanes Irma and Maria last year.

“We do not want to have to go through a typhoon to get more Medicaid money,” said Sablan. “Besides, we need a long-term solution, not just the short-term patch provided for the Caribbean islands to help with storm recovery.”

Local legislative action could speed expenditure.

One solution Sablan has proposed is to lift the cap on Medicaid funding for the insular areas. “States can spend as much as they want on Medicaid, as long as the federal dollars are matched by the state government,” the congressman explained.

“The CNMI has been making its match using certified public expenditures rather than matching dollars with dollars,” Sablan said.

Certified public expenditures are funds the Commonwealth Healthcare Center spends on items and services that are eligible for federal matching Medicaid funds. CPE has averaged about $13 million per year.

Sablan said there may be additional certified public expenditures that the hospital could account for and use, if the cap were lifted.

“Using the CPE is smart,” Sablan said.

“But the Legislature could also start appropriating local funds to match the federal Medicaid dollars, as they once did. That, too, would be smart. Because with a 55 percent federal match you more than double your money,” he explained.

“We have over 14,000 people who depend on Medicaid directly. And anyone who goes to the hospital benefits, too, indirectly, because Medicaid money has kept the doors open. So, a financial commitment from the legislature would help improve healthcare for everyone.

“A local commitment would also help draw down our remaining Obamacare money and make the case for continued federal funding beyond 2019,” Sablan said. (PR)

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